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http://carolanderson.co blogging the business of homecare Tue, 27 Jun 2017 01:47:31 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.4 World Class Hospice Triage Nurses Needed http://carolanderson.co/2017/world-class-hospice-triage-nurses-needed/ http://carolanderson.co/2017/world-class-hospice-triage-nurses-needed/#respond Tue, 27 Jun 2017 01:39:07 +0000 http://carolanderson.co/?p=672 http://www.rnline.com/careers/


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Additional Agencies Wanted for On Call RN Triage Pilot http://carolanderson.co/2017/additional-agencies-wanted-for-on-call-rn-triage-pilot/ http://carolanderson.co/2017/additional-agencies-wanted-for-on-call-rn-triage-pilot/#respond Mon, 13 Feb 2017 16:30:29 +0000 http://carolanderson.co/?p=667 NurseLine is conducting a free pilot of our on call RN triage service with multiple participants. We are looking for more hospice agencies in the Central, Mountain and Pacific Time Zones to take part in the pilot.


Staffing on call is costly and difficult to manage. NurseLine’s RNs triage night, weekend and holiday patient and family caregiver telephone calls, contacting the appropriate on call member of the hospice center’s interdisciplinary team only when necessary. Our highly experienced hospice RNs work with our clients in a way that is transparent to patients and families using client protocols to provide telephone triage as a trusted extension of the hospice center’s staff.

Participating agencies can expect to realize the following benefits:
-reduce on call labor expense by an average of 30%.
-prevent RN staff burnout and turnover.
-easy to manage – enjoy peace of mind.
-marketers tout “Every call is answered by an RN, instead of an answering service.”
-accelerate the start of care date and increase the length of stay of night, weekend and holiday referrals


For more information, please contact Eric Edstrom at 469-878-3750 or eedstrom@RNline.com.


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Agencies Wanted for On Call RN Triage Pilot http://carolanderson.co/2017/agencies-wanted-for-on-call-rn-triage-pilot/ http://carolanderson.co/2017/agencies-wanted-for-on-call-rn-triage-pilot/#respond Mon, 09 Jan 2017 14:17:04 +0000 http://carolanderson.co/?p=658 NurseLine is seeking hospice agencies in the Central Time Zone to participate in a free, no obligation pilot of our on call RN triage service.


Staffing on call is costly and difficult to manage. NurseLine’s RNs triage night, weekend and holiday patient and family caregiver telephone calls, contacting the appropriate on call member of the hospice center’s interdisciplinary team only when necessary. Our highly experienced hospice RNs work with our clients in a way that is transparent to patients and families using client protocols to provide telephone triage as a trusted extension of the hospice center’s staff.

Participating agencies can expect to realize the following benefits:
-reduce on call labor expense by an average of 30%.
-prevent RN staff burnout and turnover.
-easy to manage – enjoy peace of mind.
-marketers tout “Every call is answered by an RN, instead of an answering service.”
-accelerate the start of care date and increase the length of stay of night, weekend and holiday referrals


For more information, please contact Eric Edstrom at 469-878-3750 or eedstrom@RNline.com.


Thank you for your help!



Eric Edstrom



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How do you hire a fraction of a an employee? http://carolanderson.co/2016/how-do-you-hire-a-fraction-of-a-an-employee/ http://carolanderson.co/2016/how-do-you-hire-a-fraction-of-a-an-employee/#respond Wed, 28 Sep 2016 13:21:17 +0000 http://carolanderson.co/?p=650 By using Fractional On-Call Telephone Hospice Triage RN’s!

Staffing on call is costly and difficult to manage.  NurseLine,

triages night, weekend and holiday patient and family caregiver calls over
the phone, contacting the appropriate on call member of your hospice
center’s interdisciplinary team only when necessary. Our highly experienced
hospice RNs work with you in a way that is transparent to patients and
families using your protocols to provide telephone triage as a trusted
extension of your center’s staff.

The key benefits of NurseLine’s service are:

-reduced labor expense
-prevent staff burnout and turnover.
-easy to manage, buy only what you need
-accelerate the start of care date and increase the length of stay of night,
weekend and holiday referrals

Check out www.rnline.com and contact Eric for more info!


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Most popular hospice software EMR? http://carolanderson.co/2016/most-popular-hospice-software-emr/ http://carolanderson.co/2016/most-popular-hospice-software-emr/#respond Tue, 27 Sep 2016 17:33:21 +0000 http://carolanderson.co/?p=647 Hello readers!

I am interested in your feedback about the EHR you are using or have used and what you like/dislike about it.

I’ll post the results when I get some substantial data~!



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After Hours On-Call Solutions http://carolanderson.co/2016/after-hours-on-call-solutions/ http://carolanderson.co/2016/after-hours-on-call-solutions/#respond Fri, 24 Jun 2016 00:31:09 +0000 http://carolanderson.co/?p=640  


www.RNLine.com is a new solution to an old problem.

NurseLine provides hospice specialized triage services. The service provides hospice certified and experienced  RN’s to answer your patient’s/facility call after hours. A live RN to answer the phone instead of complicated voice mail prompts that can prove frustrating to patients and families in time of  crisis.

NurseLine provides the hospice with quality, compassionate, calm confidence with  hospice RN’s that answer each patient’s call. The RN can contact the medical director for orders as necessary, order medications within the hospice’s formulary and notify RN’s or LPN’s for the need of a visit as indicated. The NurseLine RN will follow up with the patient/family/facility to ensure satisfaction and favorable outcomes.

The experienced hospice RN can also assist the hospice in containing costs by their knowledge of hospice appropriate interventions that have been proven to be clinically as well as financially effective. This same knowledge can drastically reduce hospitalizations and continuous care costs.

For more information; contact myself carolandersonrn@gmail.com or Eric Edstrom at eedstrom@RNLine.com



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Hospice CAHPS : Get Ready! http://carolanderson.co/2015/hospice-cahps-get-ready/ http://carolanderson.co/2015/hospice-cahps-get-ready/#respond Fri, 30 Jan 2015 22:14:41 +0000 http://carolanderson.co/?p=618 pinnacleHospice CAHPS is here. If you have cared for more 50 or more decedents you will need to make a “dry run” before April 1st. Results from this dry run will not be published but demonstrates you have transmission capacities.

Be ready to participate in the H-CAHPS process, it’s MANDATORY!

Thanks to my friends at Pinnacle Quality Insight  I’ve posted this FAQ from their website at http://hospicecahps.com/faq/

Hospice CAHPS® Frequently Asked Questions

What is Hospice CAHPS®?


Hospice CAHPS® is a customer satisfaction survey for hospice providers. It is also called the CAHPS® Hospice Survey. It was previously called the Hospice Experience of Care Survey.

It is a standardized survey that will be conducted with the family members or close friends of deceased recipients of hospice care.

The Hospice CAHPS® survey is part of a family of surveys that spans across many different levels of care. CAHPS® stands for Consumer Assessment of Healthcare Providers and Systems.

This family of surveys belongs to the Agency for Healthcare Research and Quality (AHRQ) a branch of the US Department of Health & Human services.

How will the surveys be administered?


The surveys must be administered by a CMS-approved vendor. A list of the approved vendors can be found here: http://hospicecahpssurvey.org/Content/ApprovedSurvey.aspx

The surveys may be conducted via phone, mail, or both. Different vendors are approved for different methodologies. It is up to the hospice agency to contract with a vendor that is approved for their preferred methodology (e.g. phone, mail, mixed).

The surveys will be conducted with family/friends of deceased hospice patients no sooner than two months after the hospice patient passes away.

The family member or friend will be asked about specific experiences with their hospice care provider.

Can the survey be customized?


On behalf of the hospice agency, the survey vendor is able to add up to 15 hospice-specific supplemental questions at the end of the survey. There are several types of questions which cannot be asked as supplemental questions. The survey vendors will have more information about this.

When does it start?


The survey will be fully implemented on April 1st, 2015. However, participating agencies will be required to conduct a “dry run” sometime during quarter 1 of 2015. The “dry run” is a survey that will be conducted with actual family members of decedents, but the results of that survey will never be made public.

Agencies will need to contract with an approved vendor prior to the “dry run” period.

Who should participate?


Agencies that served less than 50 decedents between Jan 1, 2014 and Dec 31, 2014 are exempt from participating in the survey. Also, new agencies do not have to participate in the survey during the calendar year in which they received their CCN.

All other agencies must participate in the survey to receive their full APU. Agencies opting not to participate will receive a 2% reduction in their Medicare rate.

How do you participate?


In order for an agency to participate, they need to contract with an approved survey vendor and supply that vendor with the patient information needed to conduct surveys each month.

Who pays for it?


The hospice agency is responsible for the cost of conducting the survey. Different survey vendors charge different amounts.

Please contact us to get a custom bid for you agency.

What if an agency gets poor marks?


As of now the survey results are not tied to reimbursement rates. However, the results of the survey will eventually be made public. Bad reviews from customers could have a negative impact on potential new customers.


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A Hospice Story http://carolanderson.co/2015/a-hospice-story/ http://carolanderson.co/2015/a-hospice-story/#comments Thu, 29 Jan 2015 04:11:26 +0000 http://carolanderson.co/?p=613 garden gate 2

Rural San Diego County, California is about as close to heaven as I can imagine. I drove long distances between my patient’s homes on mountain roads lined with all sorts of flowering bushes and trees. It was sunny and 70 almost year round. I was driving through a lemon grove on the top of a small mountain with the scent of citrus wafting through my windows when I said to myself “I can’t believe they pay me to do this.” As I came to the end of the last line of lemon trees I realized I was at the very top of the mountain and at my patient’s wide brick driveway. As I was driving up to the gorgeous stucco home a tanned, blonde lady in her 40’s came bouncing down the steps in white shorts and a pink halter top. She stood beside my door as I scrambled to park, unbuckle my seatbelt and gather all the forms and tools I knew I would need. I was yet to realize that this was my new patient.


Sandra was unlike any person I had ever met, even more unlike any hospice patient I had ever cared for. She greeted me as if I were a long lost best friend. She showed me around her beautiful home and was especially proud of the pool with the manmade waterfall and stone bridge that crossed over it. Finally, we sank into her white leather sofa and joined by her husband she got right to it. “What’s it like?”, “Will it hurt?” “Will I know when I’m dying” “Will I be in a coma?” “Will I have to wear diapers?” Now, I am used to talking about all these things however, I am usually the one that struggles with when, and how to present this information to my patients. We spent several hours answering each other’s questions. I learned she had a tube in her stomach because she had difficulty swallowing, she had liver cancer of unknown origin which had spread to several other sites and had caused restriction of her esophagus, she could only tolerate liquids and ice cream, and she was not experiencing pain. I filled out the mountains of forms, collected all her history and reviewed her medications and set up our next appointment. She walked me through the arched front door and through her meticulously landscaped courtyard to the wrought iron gate. She waved goodbye and I drove back through the lemon grove and on to my appointed rounds.


When I saw Sandra a few days later she complained of moderate pain in her right side. She described it as a dull knife tearing through a tough steak. I knew that she was probably feeling the highly sensitive liver capsule stretch as the tumor grew. We started a pain regimen that would soon become the most extensive that I had ever managed. Sandra continued to be mobile, and cheerful. Sometimes we would visit in the living room, sometimes by the pool, sometimes in her bedroom and sometimes she would hold court in her bathroom at her makeup mirror as she continued to apply mascara, even when she had failed to remove it the day before, but she ALWAYS walked me to the gate at the end of our visit.


Sandra had fantasized several times about what her last Christmas would be like. It was only a few months away. Sandra realized before I did that she had probably already had her last Christmas. She set her sites instead on planning a vow renewal ceremony with her husband on the stone bridge overlooking the pool. It was scheduled for a month away. I was making daily visits to assess her pain, change her meds, eventually giving morphine, and then Dilaudid via a pump. The medical director came once every week to help me figure out what to do next. Still, leaning on her IV pole, against my loud and insistent orders, Sandra continued to walk me to the gate.


Sandra ended up on Continuous Care for a record-breaking 39 days. She refused to go to the hospital and honestly, I don’t think she would have received any better results in that setting. Her Continuous Care nurse walked her up the stone bridge for her vow renewal ceremony; she fell asleep twice during the short service. Having reached her target date, Sandra removed the mascara, tied her hair on top of her head and spent most of her remaining days in bed. Still, with the help of the Continuous Care nurse she insisted on walking me to the gate. My attempts to stop her had become a running joke. “Dammit, Sandy, you are NOT going to walk me to the gate. I’m the nurse and you have to do what I say!” She loved proving to me that I had no control over her whatsoever and when we finally, slowly reached the gate and I turned to point my finger with a mock scolding she put her hands on both my shoulders and squared herself and said “you know, you are right, I’m NOT walking you to the gate. You have been walking ME to the gate since the day I met you and it has been a beautiful journey.”


The next day, Sandra was unresponsive. She continued to live another week and remained on Continuous Care. I was present when she took her last breath. I will never forget her.



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Review of Axxess Software http://carolanderson.co/2015/review-of-axxess-software/ http://carolanderson.co/2015/review-of-axxess-software/#comments Sun, 18 Jan 2015 22:52:15 +0000 http://carolanderson.co/?p=598 I admit this review is long overdue.

I’ve been seeing Axxess being utilized in the majority of agencies that I’ve visited as both a surveyor and consultant. As it turns out, it is because they have over 1800 home health clients since their inception in 2011. That’s pretty impressive.

I had a long chat and demo with Diane Cahill, whom I found more than knowledgeable about the many functions of the application and I started the phone call with a few “bones to pick” regarding the way I’ve seen the software utilized in the agencies I’ve visited. You know I come to every demo with my own agenda! (by the way, I’m told it rude to show up at someone else’s meeting with your own agenda…but their agenda is usually boring lol)

If you read my earlier post about the QA craziness, I had identified that today’s software programs force every single stinking document to QA (or somewhere) for review! The agencies I’ve seen, especially those with over 100 patients had several FTEs that did nothing but hit that approve button! So Diane endured a bit of my rant and then led me gently to the settings where that function can be turned off.

Now mind you, it is turned of by user, not by document. That could make sense if I am reviewing a new employees charting as part of their on-boarding to the agency. However, if you want to use that sweet function where you decide to just look at a sample (say 10%) instead of every single stinking note you will only see the documents created by clinicians that have not been “turned off”. That’s not as helpful in a lean, green QA program.

Note to Axxess: Beautiful QA function,. but give us the option  look at a sample of documentation across the board regardless of the review by QA setting under each role. It may also be worth considering having the option to turn off this QA review function by document in addition to user.

A real game changer for me was the ability for a nurse or owner who is involved in more than one agency has to sign on only once to have access to all the agencies they are involved in!.

An unfortunate trend in home health is that nurses are working for more than one company and I think it is a terrific advantage (and recruiting benefit). If I MUST work for more than one agency, I can at least document on the same system with one log in. No bleed-over, you have to choose the agency when you log in and don’t need to worry about charting or emailing the wrong agency about a patient.

Note to Axxess: Consider consolidating the scheduling feature, what a boon that would be! As a clinician I can see my actual schedule across all agencies. I would recommend that scheduling of a patient for one agency be viewed only as “unavailable” by other agency employers so they will know that person is not available due to a scheduled visit for another agency.

An underused feature that would be of great benefit is the OASIS scrubber. Have the nurses check it and complete the corrections…another way to stop the QA madness.

Speaking of QA, Axxess maintains all your QA surveillance in the system. (donate those binders to schools that need them!) There are incident surveillance reports (they are not a part of the actual patient record, they are just stored in the system and cannot be access except through reporting. Similar to the paper version in which they cannot be accessed except through picking up the binder.

Note to Axxess: Make quarterly reporting on this surveillance data meaningful. Trend it quarter to quarter or month to month with automatic percentages based on the census. In other words, it’s one thing to know I had 10 infections and 2 incidents this quarter, but what percentage is that? The number of occurrences may have gone up or down, but so has my census. The data is useless without that denominator. The census data is in the system, there should be a way of automating that instead of staff having to run the reports (and you know they are going to either get the parameters wrong or not run it the same way every time). Allow us to visualize the percentages in graphs (just like the outcomes on home health compare.)

There were many features that I had not realized were available in Axxess, because most of the agencies aren’t using them. I love that the calendar/schedule flows to payroll (no more rout sheets)

There are mobile apps with gps verification. It only marks the visit verified if someone signs that signature pad, but depending on your policy it does not have to be the patient. (Remember that Medicare, nor CHAP requires patient signatures and if you think you are validating their visits with those signatures, you are naïve!)

Note to Axxess: Make that signature optional while maintaining the gps validation. Is that possible?

Another BIG bone to pick! parameters on the 485 must be completed on every single patient, what a pain. The medical profession has long had standard parameters for normal vital signs, Axxess, please pre-populate them, but give us the option to change them according to the physician’s expectation for the patient. 99 times out of 100, the parameters will be based on best practices.  OASIS completion is hard enough without adding the work of entering parameters.

Note to Nurses: Please complete the OASIS assessment during the visit. There are far reaching clinical and financial implications associated with that document and you cannot possibly remember a thorough 21 page assessment for entry later at home.

Note to Owners: Invest in a 4g device large enough to document the OASIS assessment. Yes, they may use it for personal use, the point is they can do a better OASIS assessment which contributes to your reimbursement and the speed of cash flow.

Now for the deets: There is no long term contract. There is a written agreement for 12 months with a 90 day out. New and small agencies can take advantage of paying by census 1-25 census is $499/month. This is especially beneficial since you will probably have more part time users than your larger competitors. Larger agencies can pay by users: 1-5 users is $499/month. If you choose the census option, you can have unlimited users. If you choose the user option you have unlimited patients.

A Private Duty application is due to be released live this spring and while they have plans to do hospice. I’m going to bug the crap out of them until they get that done! They are located near my home in Dallas, so I will go down there if I have to!






Cost! No built in best practice parameters
True Paperless Potential Care plan options generic and sometimes inappropriate (placing services provided on first visit in 485 is not good practice)
Built in payroll (no redundant route sheets) QA surveillance data does not trend
Mobile apps Can’t QA a true sample of agency documents unless agency has selected to review EVERY clinician
Encrypted in-application email Can’t turn off “Send to QA “ by document (by user only)
Schedule options (by clinician or scheduler) Generic interventions and goals (utilize best practices, probable care plans based on data from the experts (American Heart Association, American Diabetic Association, American Association of Heart Failure Nurses
Single sign on for multiple agencies Does not populate visit note with interventions and goals that can prompt nurse as to what is expected according to the care plan and address progress towards goals. (We’ve had this ability since 1999)
Can turn off that stinking QA review process  
Can be accessed anywhere with internet connection on any device




Very intuitive interface (I’ve never received training, but I love to just push buttons and see what happens More focused care plans
Free training—Free CEU’s Populating the interventions and goals to each note so they can be addressed
Recruiting potential as utilizers of most popular software in the small/mid-size agency Add ability to report on interventions and goals that have not been addressed as part of final audit
Integrated Human ResourcesTrack requirements in Axxess instead of addl applications. Add parameters based on best practices to 485 with option to individualize.
Built in OASIS guidance—throw away the books. Hover over the question and it describes what Medicare xpects Get rid of that patient signature (or at least give option to turn it off)
OASIS Scrubber function for RN’s to analyze PRIOR to submission (when you’re ready to cut the QA apron strings) Provide option to skip QA by documents

 Final impressions:

I understand why it is such a popular product. I’m anxious to see what they will do next.

I wonder if a circling back with the training would be worthwhile to maximize the features of the application, improving not only satisfaction amongst users but improved clinical and financial outcomes.

Home Health Owners: Get your money’s worth out of any software, but especially with Axxess. Of all the times I’ve heard “Axxes won’t let you do that” I’ve learned that it is not an Axxess issue, it’s a settings issue.

Profit margins are getting slimmer and slimmer. It is imperative that we spend our money wisely. Revising QA processes is one, using your technology to reduce redundancy and allow your nurses (who are in short supply) to do the things that only they can do!

To that end, to those of you who are maintaining paper charts as well as electronic charts you are not only  wasting the cost savings intended with the adoption of technology. It costs money to manage paper, maintain clinical files, store clinical files, review clinical files. Reconsder this practice! Choose a software solution that not only takes the place of clinical records but personnel records, agency logs, and communication via email notes and communication notes added to patient records as well.

Axxess is a smart choice. Learning as much as you can and utilizing to its fullest potential is genius.

To schedule a demo or learn more about the features, visit www.axxess.com. Diane Cahill does a terrific demo, but she assures me that the entire staff is more than capable of presenting a comprehensive demo.

Any current Axxess users are welcome to respond to this post. Post a comment, anonymously if desired. Just remember my mama reads this (supposedly) so keep it clean folks.

I would love to hear especially about the features you find most useful, obstacles you’ve been unable to overcome and any experience with customer service.







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